Patient discourse on chronic kidney disease monitoring: a qualitative study at a Veterans Affairs Renal Clinic
Abstract Background Knowing how chronic kidney disease (CKD) patients talk about their encounters with providers (i.e., their discourse) can inform the important clinical goal of engaging patients in their chronic disease self-management. The aim of this study was to analyze patient discourse on ong...
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| Format: | Article |
| Language: | English |
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BMC
2018-07-01
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| Series: | BMC Nephrology |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12882-018-0981-7 |
| _version_ | 1829470225133731840 |
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| author | Ann E. Vandenberg Katharina V. Echt Theodore M. Johnson C. Barrett Bowling |
| author_facet | Ann E. Vandenberg Katharina V. Echt Theodore M. Johnson C. Barrett Bowling |
| author_sort | Ann E. Vandenberg |
| collection | DOAJ |
| description | Abstract Background Knowing how chronic kidney disease (CKD) patients talk about their encounters with providers (i.e., their discourse) can inform the important clinical goal of engaging patients in their chronic disease self-management. The aim of this study was to analyze patient discourse on ongoing CKD monitoring encounters for health communication strategies that motivate patient engagement. Methods Passages regarding CKD monitoring from 6 focus group transcripts on self-management with a total of 30 participants age ≥ 70 years from the Atlanta Veterans Affairs Renal Clinic across three different CKD trajectories (stable, linear decline, and non-linear) were extracted. These passages were examined using three-stage critical discourse analysis (description, interpretation, explanation) for recurring patterns across groups. Results Focus group participants were an average age of 75.1, 96.7% male, and 60% Black. Passages relating to CKD monitoring (n = 55) yielded predominantly negative communication themes. Perceived negative communication was characterized through a patient discourse of unequal exchange, whereby engaged patients would provide bodily fluids and time for appointments and continued to wait for meaningful, contextualized monitoring information from providers and/or disengaged providers who withheld that information. However, some encounters were depicted as helpful. Perceived positive communication was characterized by a patient discourse of kidney protection, whereby patients and providers collaborate in the mutual goal of preserving kidney function. Conclusions Patient perceived an unequal exchange in CKD monitoring encounters. This perception appears rooted in a lack of easily understandable information. By accessing the positive discourse of protecting the kidneys (e.g., through eGFR level) vs. the discourse of damage (e.g., serum creatinine level), healthcare professionals can clarify the purpose of monitoring and in ways that motivate patient engagement in self-management. Patients being monitored for CKD progression may best be supported through messaging that conceptualizes monitoring as kidney protection and provides concrete contextualized information at each monitoring encounter. |
| first_indexed | 2024-12-14T01:42:23Z |
| format | Article |
| id | doaj.art-7271045719f94eeb8759546121545885 |
| institution | Directory Open Access Journal |
| issn | 1471-2369 |
| language | English |
| last_indexed | 2024-12-14T01:42:23Z |
| publishDate | 2018-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Nephrology |
| spelling | doaj.art-7271045719f94eeb87595461215458852022-12-21T23:21:40ZengBMCBMC Nephrology1471-23692018-07-011911910.1186/s12882-018-0981-7Patient discourse on chronic kidney disease monitoring: a qualitative study at a Veterans Affairs Renal ClinicAnn E. Vandenberg0Katharina V. Echt1Theodore M. Johnson2C. Barrett Bowling3Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs, Atlanta VA Medical CenterBirmingham/Atlanta Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs, Atlanta VA Medical CenterBirmingham/Atlanta Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs, Atlanta VA Medical CenterDurham Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs, Durham VA Medical CenterAbstract Background Knowing how chronic kidney disease (CKD) patients talk about their encounters with providers (i.e., their discourse) can inform the important clinical goal of engaging patients in their chronic disease self-management. The aim of this study was to analyze patient discourse on ongoing CKD monitoring encounters for health communication strategies that motivate patient engagement. Methods Passages regarding CKD monitoring from 6 focus group transcripts on self-management with a total of 30 participants age ≥ 70 years from the Atlanta Veterans Affairs Renal Clinic across three different CKD trajectories (stable, linear decline, and non-linear) were extracted. These passages were examined using three-stage critical discourse analysis (description, interpretation, explanation) for recurring patterns across groups. Results Focus group participants were an average age of 75.1, 96.7% male, and 60% Black. Passages relating to CKD monitoring (n = 55) yielded predominantly negative communication themes. Perceived negative communication was characterized through a patient discourse of unequal exchange, whereby engaged patients would provide bodily fluids and time for appointments and continued to wait for meaningful, contextualized monitoring information from providers and/or disengaged providers who withheld that information. However, some encounters were depicted as helpful. Perceived positive communication was characterized by a patient discourse of kidney protection, whereby patients and providers collaborate in the mutual goal of preserving kidney function. Conclusions Patient perceived an unequal exchange in CKD monitoring encounters. This perception appears rooted in a lack of easily understandable information. By accessing the positive discourse of protecting the kidneys (e.g., through eGFR level) vs. the discourse of damage (e.g., serum creatinine level), healthcare professionals can clarify the purpose of monitoring and in ways that motivate patient engagement in self-management. Patients being monitored for CKD progression may best be supported through messaging that conceptualizes monitoring as kidney protection and provides concrete contextualized information at each monitoring encounter.http://link.springer.com/article/10.1186/s12882-018-0981-7Health communicationChronic kidney diseaseChronic disease self-managementPatient engagementPatient-centered care |
| spellingShingle | Ann E. Vandenberg Katharina V. Echt Theodore M. Johnson C. Barrett Bowling Patient discourse on chronic kidney disease monitoring: a qualitative study at a Veterans Affairs Renal Clinic BMC Nephrology Health communication Chronic kidney disease Chronic disease self-management Patient engagement Patient-centered care |
| title | Patient discourse on chronic kidney disease monitoring: a qualitative study at a Veterans Affairs Renal Clinic |
| title_full | Patient discourse on chronic kidney disease monitoring: a qualitative study at a Veterans Affairs Renal Clinic |
| title_fullStr | Patient discourse on chronic kidney disease monitoring: a qualitative study at a Veterans Affairs Renal Clinic |
| title_full_unstemmed | Patient discourse on chronic kidney disease monitoring: a qualitative study at a Veterans Affairs Renal Clinic |
| title_short | Patient discourse on chronic kidney disease monitoring: a qualitative study at a Veterans Affairs Renal Clinic |
| title_sort | patient discourse on chronic kidney disease monitoring a qualitative study at a veterans affairs renal clinic |
| topic | Health communication Chronic kidney disease Chronic disease self-management Patient engagement Patient-centered care |
| url | http://link.springer.com/article/10.1186/s12882-018-0981-7 |
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